Hillary’s health plan

It was at about this stage of presidential selection in 1992, though much later on the calendar, that Bill Clinton, wanting to change the subject, declared in a debate that it made no difference which Democrat was nominated and elected because national health insurance was a certainty. All of the candidates and nearly all Americans favored it, so Congress unavoidably would guarantee health coverage for everyone in the new president's first year.

Hillary Clinton has wanted to change the subject, too, for the expedient reason that it was the disaster that followed that fixed her unpleasant persona: secretive, headstrong, calculating and naïve. Although blame should have been spread around, she bore the onus for the biggest policy defeat in modern times, unless you count George W. Bush's botched Social Security reforms. Who could blame her for not wanting to return to the scene of the crime?

When she did roll out her plan for universal coverage last month, Bill Clinton's prediction seemed far more apt than in 1992. For the first time since Harry Truman called for universal health insurance in 1948, the stars seem aligned for it. All the Democratic candidates favor it, and except for Dennis Kucinich they embrace something very close to her plan. Three of every four Americans want universal coverage even if it means higher taxes. When the next president takes office, more than 50 million Americans will have no health insurance. Manufacturers and the health and insurance industries want something done.

So a Hillary Clinton prediction of a fait accompli like her husband's — she didn't make it — would sound unassailable. A Democratic presidential victory and another Democratic tide in the congressional elections, which seems likely with Republican incumbents bowing out of the election every week, would make it virtually certain. Democrats need only a real working majority in the Senate, four or five more seats.

The spoiler would be a grave political miscalculation or two. As it happens, the Clintons made them in abundance in 1993 and 1994, which scotched health insurance reform for 15 years. Sen. John Edwards, who long ago offered a plan for universal coverage very close to hers, said millions of people have gone without proper coverage for a dozen years because of her failure.

She said last week that she was much wiser now than in 1994, and that is beyond doubt. The first evidence was that she made no effort to defend the 1994 plan or to combat any of the misrepresentations about it, which continued to fill the reporting and commentary about her new plan: that the old one forced people to give up their old health insurance and go into a government-run plan in which they could not choose their doctor or hospital, that doctors would be government employees, that it did away with patient choice. None of that was true, but the new, wiser, happier Hillary Clinton is not going to engage in pointless battles.

The reason for her confidence, she said, was that this time it is a plan that she devised, and she will make the decisions. It was a polite way of saying that the 1994 plan was her husband's and that he made the pivotal decisions that caused the collapse of health reform in 1994. He later told Haynes Johnson, who wrote a book about the health-care flop with David Broder, that the critical mistake was to push for enactment after Sen. Robert Byrd ruled that it could not be attached to the budget rather than waiting. “This is entirely my mistake, no one else's,” he said. “I set Congress up for failure.”

But Hillary Clinton bore the mark of the failure because his appointment of her to chair the task force that drafted the plan assigned her credit and blame for everything.

The new Hillary health-care plan is fundamentally like the old one but without all the regulatory detail that flummoxed Americans and without the layer of health-care “alliances” and the confusing nomenclature like “managed competition” that allowed opponents to create scary scenarios.

It builds on the current employer-based private health insurance system. (The 1994 plan was a bonanza for insurance companies, which some of the big ones recognized in spite of what the Harry and Louise ads might have led you to think.) Like the old one, it will expand people's health-care choices, not limit them, although the choices will not be as expansive as the 1994 plan's.

Pointedly, Sen. Clinton said people could keep their current insurance. Contrary to the ads, they could have kept their insurance in 1994, too, assuming that companies continued to offer the same plans. The new Hillarycare will offer the same variety of choices members of Congress have — HMOs, PPOs, fee for service — or a Medicare-like plan. It would offer an interesting competition between a Medicare plan and private companies so that we could see just how well the industry's 17-percent administrative margin competes.

It is not at all dissimilar to the plan pushed through the Massachusetts legislature by Gov. Mitt Romney, who immediately denounced Mrs. Clinton's plan, or the one proposed in 1993-94 by Sen. John Chafee, R-Rhode Island, before the party told him to shut it down because the strategy became not to pass workable health-care reform but to prevent Clinton and the Democratic Congress from achieving anything.

Things look more propitious for 2009, but that strategy will be unchanged.

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